1979, 12-03 Permit: 79-8596 Plumbing FixturePLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY - BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 4 COPIES
3
4' ADDR
JOB ADDRESS
LOT
OWN
BLOCK
SUBDIVISION
ADDRES$-
CONTRA
4
Z) & 3 -2 7
DESIGNER
a717 V
ZIP
7
c
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
Required Set Backs in Feet
North South [East
Size of Parcel
Type Const.
Occupancy
West
Zone Classification
Sprinklered
❑Yes ❑No ❑ Req'd.
PHONE
Valuation
Building Area in Sq. Ft.
ADDRESS
ZIP
DWL Area
IBasement Area
Garage Area I Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
* PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
O POOL
0 OTHER
No. Baths
No. Floors
CERTIFICATE
of EXEMPTION
No. Rooms
Req'd.
Rec. Room
Rec'd.
Not Req'd.
DESCRIBE WORK
8.
VALUATION
9.
Source
of
Utilities
GAS
ELECTRIC
WATER
SEWER
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or local law regulating construction or
performance of construction.
DATE SIGNATURE
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
SPECIAL CONDITIONS:
FEES COLLECTED
//
___22
DATE/Oh" OFFICIAL 41-t�LdL/L'
APPROVED FOR ISSUANCE
Mobile Home
Other (Specify)
TOTAL
PERMIT NUMBER
DATE
03* *5,50
* 550
* 5506
B *000
859.52
12-03-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS B COME A P MIT.
l2 -f.) -7
859.62 #5.50,2F